Hypokalemia and the Prevalence of Primary Aldosteronism

Abstract

Hypokalemia is closely linked with the pathophysiology of primary aldosteronism (PA). Although hypokalemic PA is less common than the normokalemic course of the disease, hypokalemia is of particular importance for the manifestation and development of comorbidities. Specifically, a growing body of evidence demonstrates that hypokalemia in PA patients is associated with a more severe disease course regarding cardiovascular and metabolic morbidity and mortality. It is also well appreciated that low potassium levels per se can promote or exacerbate hypertension. The spectrum of hypokalemia-related symptoms ranges from asymptomatic courses to life-threatening conditions. Hypokalemia is found in 9–37% of all cases of PA with a predominance in patients with aldosterone producing adenoma. Conversely, hypokalemia resolves in almost 100% of cases after both, specific medical or surgical treatment of the disease. However, to date, high-level evidence about the prevalence of primary aldosteronism in a hypokalemic population is missing. Epidemiological data are expected from the recently launched IPAHK+study (“Incidence of Primary Aldosteronism in Patients with Hypokalemia”).

Comparison of Clinical Features between Primary Aldosteronism and Essential Hypertension in Chinese Patients: A Case-Control Study

“…All patients provided their written informed consent to participate in this study. 3) patients who had used or were still using diuretics, beta blockers, central alpha 2 blockers, and nonsteroidal anti-inflammatory drugs in the past 2 weeks; (4) patients who had used aldosterone receptor antagonists (such as spironolactone) in the past 4 weeks; (5) patients who had histories of various types of diabetes combined with severe cardiovascular and cerebrovascular diseases, such as severe cardiac insufficiency, ischemic, or hemorrhagic cerebrovascular accidents in the past 1 year; (6) patients who had severe liver or kidney diseases; (7) patients who were pregnant and lactating women; (8) patients who had a history of immune diseases or use of steroid drugs within 3 months; (9) patients suffering from mental illness or using antipsychotics. In addition, twenty-two patients with nonfunctioning adenomas without abnormal glucose, lipid metabolism, and hypertension were recruited for metabolic analysis, serving as a comparison reference when comparing the glucose metabolism between PA patients and EH patients.…”

“…The main clinical feature of PA is excessive potassium excretion and sodium and water retention that could lead to extracellular fluid expansion and increased blood volume because of the increased secretion of aldosterone. The incidence of hypokalemia in patients with PA is 9% to 37% [ 6 ]. In recent years, studies have shown that PA is more common in refractory hypertension and grade 3 hypertension [ 2 ].…”

Incidence of Primary Aldosteronism in Patients with Hypokalemia (IPAHK+): Study Design and Baseline Characteristics

“…Last but not least, also patients with spontaneous or diuretic-induced hypokalemia and simultaneous hypertension are screening candidates [8]. The link between hypokalemia and PA is plausible from a pathophysiological point of view and proven by numerous studies [8][9][10][11]. However, prevalence data of PA in a hypokalemic population independent of other factors such as hypertension are still missing.…”

“…However, prevalence data of PA in a hypokalemic population independent of other factors such as hypertension are still missing. Hypokalemia is of particular importance in the context of the disease with respect to pre-analytics, differential diagnosis, course of disease, treatment and prognosis [8,9]. The IPAHK + trial, which was launched in October 2019, will provide the first high-level evidence data on the incidence of PA in an unselected hypokalemic outpatient cohort.…”

Progress in Primary Aldosteronism 2019: New Players on the Block?

“…The manuscripts are organized according to their relation to the diagnostic and therapeutic challenges of PA. The study of Gruber and Beuschlein [6] analyses the relevance of hypokalemia as a lead symptom for PA. An important clinical manifestation of PA is atrial fibrillation, as outlined by the study of Pan et al [7]. A conundrum has been the association between PA and obstructive sleep apnea syndrome, which has recently received quite some attention and is covered in this issue by Pecori et al [8].…”